Explanatory Statement Form - 1999 Page 6

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CERTIFICATION BY APPLICANT FOR POST-SALE REGISTRATION OF
SECURITIES
The undersigned applicant for registration of securities pursuant to Section 36b-
19(k) of the Connecticut Uniform Securities Act and Section 36b-31-19c of the
Regulations thereunder certifies to the Connecticut Banking Commissioner as follows:
1.
Substantially all of those persons to whom the unregistered securities were sold
have signed the post-sale registration document consisting of an Explanatory
Statement and Statement of Non-prejudice; and
2.
Included herewith are the signed documents referenced above.
Print Name of Applicant for
Securities Registration:
______________________________
Signature of Executive
Officer or Authorized
Person of Similar Rank:
______________________________
Print Name of Signatory:
______________________________
Date:
______________________________
Revised 3/17/1999

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